December 19, 2001
Castleman's disease is caused by a virus that also causes another AIDS-related disorder -- Kaposi's sarcoma. This virus, called KSHV (Kaposi's sarcoma-associated herpes virus), infects a type of immune cell called B-cells, overstimulating them. These infected B-cells grow abnormally and multiply rapidly, fill up lymph nodes and produce higher-than-normal levels of antibodies. There is no standard treatment for Castleman's disease.
Doctors in Milan, Italy, reported the successful treatment of an HIV positive woman who had Castleman's disease. She was treated with a new anti-cancer therapy that is called Rituxan (rituximab) in North America and Mabthera in Europe. This drug is different from many other anti-cancer therapies in that it consists of antibodies that attack a protein found on B-cells that have turned into tumours.
After four months of this new anti-HIV combination, the woman's viral load fell below the 80 copy mark. She continued to receive chemotherapy every three weeks. After six months of triple chemotherapy, her anti-cancer regimen was changed to intravenous liposomal daunorubicin given every two to four weeks. After four months of this new chemotherapy, CAT scans of her body did not reveal any swelling in her lymph nodes or spleen. Yet, shortly after each cycle of chemotherapy was complete, the following symptoms returned:
Along with these symptoms, levels of KSHV in the woman's blood rose. Two years after she first sought medical attention, doctors decided to give her a single intravenous dose of the new anti-cancer drug rituximab. KSHV levels fell to undetectable levels and her symptoms cleared. No side effects were reported and no changes to CD4+ and CD8+ cell counts or viral load were noted.
These results are exciting but further study is needed to find out if rituximab alone can help people with HIV/AIDS recover from Castleman's disease or if pre-treatment with chemotherapy and highly active antiretroviral therapy is needed.
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